<%--
  Created by IntelliJ IDEA.
  User: houxianghua
  Date: 2015/10/12
  Time: 15:59
  To change this template use File | Settings | File Templates.
--%>
<%@ page contentType="text/html;charset=UTF-8" language="java" %>
<%@ include file="/WEB-INF/jsp/component/common.jsp" %>
<!DOCTYPE html>
<html lang="zh-CN">
<head>
  <meta charset="utf-8">
  <meta http-equiv="X-UA-Compatible" content="IE=edge">
  <meta name="viewport" content="width=device-width, initial-scale=1">
  <meta name="description" content="">
  <meta name="author" content="">
  <title>随访主页面</title>
  <%@include file="/WEB-INF/jsp/component/commonHead.jsp" %>
  <%@include file="/WEB-INF/jsp/component/commonBottom.jsp" %>
  <%--<script type="text/javascript" src="${assets}/PIE_IE678.js"></script>--%>
  <link rel="stylesheet" href="${assets}/followUp/diabetes/css/diabetes.css" type="text/css">
  <link href="${css}/bootstrap-datetimepicker.min.css" rel="stylesheet"/>

  <script type="text/javascript" src="${assets}/followUp/diabetes/js/diabetes.js"></script>
  <script type="text/javascript" src="${assets}/followUp/diabetes/js/dell.js" charset="UTF-8"></script>

  <script src="${js}/jquery.twbsPagination.min.js"></script>
  <script src="${js}/bootstrap-dateTime/bootstrap-datetimepicker.js"></script>
  <script type="text/javascript" src="${js}/bootstrap-dateTime/locales/bootstrap-datetimepicker.zh-CN.js" ></script>
</head>
<body>
<div class="visitData">
  <!-- 个人信息 -->
  <div class="information">
    <p class="personalTitle">个人信息</p>
    <div class="detail-top">
      <label for="doctor">责任医师:</label>
      <div class="doctor">
        <input id="doctor" type="text">
      </div>
      <div class="form-group">
        <label>随访时间:</label>
        <div id="Time" class="input-group date form_date col-md-5" style="width: 146px"  data-date-format="yyyy-mm-dd">
          <input class="form-control" size="12" type="text" value="2015-07-24" readonly style="text-indent: 0">
                  	<span class="input-group-addon">
                  		<!-- <span><img src="img/calender.png" alt="" /></span> -->
                  		<span class="glyphicon glyphicon-calendar aria-hidden='true'"></span>
          </span>
        </div>
      </div>
    </div>
    <div class="detail-bottom drop-down">
      <div class="visit-type">
        <label>随访方式:</label>
        <div class="select">
          <div class="base" id="VisitType" data-value="2"></div>
          <span></span>
          <ul class="test">
            <li data-option-value="1">不详</li>
            <li data-option-value="2">家庭随访</li>
          </ul>
        </div>
      </div>
      <div class="HighBloodType">
        <label class="blank">糖尿病类型:</label>
        <div class="select">
          <div class="base" id="BloodType" data-value="1"></div>
          <span></span>
          <ul class="test">
            <li data-option-value="1">原发</li>
            <li data-option-value="2">并发感染</li>
          </ul>
        </div>
      </div>
    </div>
  </div>
  <!-- 症状 -->
  <div class="symptom">
    <div class="symptomTitle">
      症状
    </div>
    <div class="symptomDetail">
      <div class="no">
        <input type="checkbox" id="NoSymptom">
        <label for="NoSymptom">无症状</label>
      </div>
      <div class="have">
        <input type="checkbox" id="headSymptom">
        <label for="headSymptom">多饮</label>
        <input type="checkbox" id="vomiting">
        <label for="vomiting" class="Vomiting">多食</label>
        <input type="checkbox" id="tinnitus">
        <label for="tinnitus">多尿</label>
        <input type="checkbox" id="DifficultyBreath">
        <label for="DifficultyBreath">视力模糊</label>
        <input type="checkbox" id="Palpitations">
        <label for="Palpitations">感染</label>
        <input type="checkbox" id="numb">
        <label for="numb">手脚麻木</label>
      </div>
      <div class="other">
        <input type="checkbox" id="EpistaxisBleed">
        <label for="EpistaxisBleed">下肢浮肿</label>
        <input type="checkbox" id="edema">
        <label for="edema" class="Edema">体重明显下降</label>
        <input type="checkbox" id="otherDisease">
        <label for="otherDisease" class="last">其他</label>
        <input type="text" value="其他" class="otherText">
      </div>
    </div>
  </div>
  <!-- <div class="symptom">
      <div class="symptomTitle">
          症状
      </div>
      <div class="symptomDetail">
          <form class="no" action="">
              <input type="checkbox" id="NoSymptom">
              <label for="NoSymptom">无症状</label>
          </form>
          <form action="" class="have">
              <input type="checkbox" id="headSymptom">
              <label for="headSymptom">多饮</label>
              <input type="checkbox" id="vomiting">
              <label for="vomiting">多食</label>
              <input type="checkbox" id="tinnitus">
              <label for="tinnitus">多尿</label>
              <input type="checkbox" id="DifficultyBreath">
              <label for="DifficultyBreath">视力模糊</label>
              <input type="checkbox" id="Palpitations">
              <label for="Palpitations">感染</label>
              <input type="checkbox" id="numb">
              <label for="numb">手脚麻木</label>
          </form>
          <form action="" class="other">
              <input type="checkbox" id="EpistaxisBleed">
              <label for="EpistaxisBleed">下肢浮肿</label>
              <input type="checkbox" id="edema">
              <label for="edema">体重明显下降</label>
              <input type="checkbox" id="otherDisease">
              <label for="otherDisease" class="last">其他</label>

              <input type="text" value="其他" class="otherText">
          </form>
      </div>
  </div> -->
  <!-- 体征 -->
  <div class="signs">
    <div class="signsTitle">
      体征
    </div>
    <div class="signsDetail">
      <div class="signs_left">
        <div class="BloodPressure">
          <label>血压(mmHg):</label>
          <input type="text">&nbsp;&nbsp;/&nbsp;&nbsp;<input type="text">
        </div>
        <div class="weight">
          <label>体重(kg):</label>
          <input type="text">&nbsp;&nbsp;/&nbsp;&nbsp;<input type="text">
        </div>
        <div class="bmi">
          <label>体质指数:</label>
          <input type="text">&nbsp;&nbsp;/&nbsp;&nbsp;<input type="text">
        </div>
        <div class="othersigns">
          <label>其他:</label>
          <input type="text">
        </div>
      </div>
      <div class="signs_right">
        <div class="Heartrate">
          <label>心率(次/分):</label>
          <input type="text">
        </div>
        <div class="height">
          <label>身高:</label>
          <input type="text">
        </div>
        <div class="other">
          <label>足背动脉搏动:</label>
          <input type="text">
        </div>
      </div>
    </div>
  </div>
  <!-- 生活指导方式 -->
  <div class="guideWay">
    <div class="guideWayTitle">
      生活指导方式
    </div>
    <div class="guideWayDetail">
      <div class="guideWayDetail_t">
        <form action="" class="smoke">
          <label for="">日吸烟量(支):</label>
          <input type="text">&nbsp;&nbsp;/&nbsp;&nbsp;<input type="text">
        </form>
        <form action="" class="drink">
          <label for="">日饮酒量(两):</label>
          <input type="text">&nbsp;&nbsp;/&nbsp;&nbsp;<input type="text">
        </form>
      </div>
      <div class="guideWayDetail_c">
        <form action="" class="sport">
          <label for="">运动量:</label>
          <input type="text">
          <span class="week">&nbsp;次、周&nbsp;</span>
          <input type="text">
          <span>&nbsp;&nbsp;分/次</span>
        </form>
      </div>
      <form action="" class="stapleFood">
        <label for="">主食(克/天):</label>
        <input type="text">&nbsp;&nbsp;/&nbsp;&nbsp;<input type="text">
      </form>

      <div class="guideWayDetail_b drop-down">
        <div class="adjustment">
          <label>心理调整:</label>
          <div class="select">
            <div class="base" id="phychologist" data-value="2"></div>
            <span></span>
            <ul class="test">
              <li data-option-value="1">良好</li>
              <li data-option-value="2">一般</li>
            </ul>
          </div>
        </div>
        <div class="behavoir">
          <label>嘱医行为:</label>
          <div class="select">
            <div class="base" id="doctorBehavior" data-value="2"></div>
            <span></span>
            <ul class="test">
              <li data-option-value="1">良好</li>
              <li data-option-value="2">一般</li>
            </ul>
          </div>
        </div>
      </div>

    </div>
  </div>
  <!-- 辅助检查 -->
  <div class="AuxiliaryCheck">
    <div class="CheckTitle">
      辅助检查
    </div>
    <div class="Add">
      <input type="button" value="新增">
    </div>
    <table id="Check">
      <thead>
      <tr>
        <th>辅助检查项目</th>
        <th>辅助检查结果</th>
        <th>检查人</th>
        <th>检查日期</th>
        <th>操作</th>
      </tr>
      </thead>
      <tbody>
      <tr>
        <td></td>
        <td></td>
        <td></td>
        <td></td>
        <td></td>
      </tr>
      <tr>
        <td></td>
        <td></td>
        <td></td>
        <td></td>
        <td></td>
      </tr>
      <tr>
        <td></td>
        <td></td>
        <td></td>
        <td></td>
        <td></td>
      </tr>
      <tr>
        <td></td>
        <td></td>
        <td></td>
        <td></td>
        <td></td>
      </tr>
      <tr>
        <td></td>
        <td></td>
        <td></td>
        <td></td>
        <td></td>
      </tr>
      </tbody>
    </table>
    <div class="Auxiliaryinput">
      <div class="glucoseValues">
        <label for="">空腹血糖值:</label>
        <input type="text">
        <span>mmol/v</span>
      </div>
      <div class="hemoglobin">
        <label for="">糖化血红蛋白:</label>
        <input type="text">
        <span>%</span>
      </div>
    </div>
  </div>
  <!-- 服药依从性 -->
  <div class="takeMedicine">
    <div class="takeMedicineTitle">
      服药依从性
    </div>
    <div class="Medicine drop-down">
      <div class="Adherence">
        <label>服药依从性:</label>
        <div class="select">
          <div class="base" id="MedicationAdhere" data-value="2"></div>
          <span></span>
          <ul class="test">
            <li data-option-value="1">规律</li>
            <li data-option-value="2">不规律</li>
          </ul>
        </div>
      </div>
    </div>
  </div>
  <!-- 药物不良反应 -->
  <div class="AdverseReactions">
    <div class="ReactionsTitle">
      药物不良反应
    </div>
    <div class="survey">
      <input type="radio" id="have"><label for="have">有</label>
      <input type="radio" id="no"><label for="no">无</label>
      <input type="text" class="oTxt">
    </div>
  </div>
  <!-- 用药情况 -->
  <div class="drugSituation ">
    <div class="drugTitle">
      用药情况:
    </div>
    <form action="" class="drugBtn">
      <input type="button" value="新增">
    </form>
    <table id="drugTable">
      <thead>
      <tr>
        <th>序号</th>
        <th>药物名称</th>
        <th>药物类型</th>
        <th>用量</th>
        <th>药物单位</th>
        <th>用法</th>
        <th>使用总剂量</th>
        <th>给药方式</th>
        <th>操作</th>
      </tr>
      </thead>
      <tbody>
      <tr>
        <td></td>
        <td></td>
        <td></td>
        <td></td>
        <td></td>
        <td></td>
        <td></td>
        <td></td>
        <td></td>
      </tr>
      <tr>
        <td></td>
        <td></td>
        <td></td>
        <td></td>
        <td></td>
        <td></td>
        <td></td>
        <td></td>
        <td></td>
      </tr>
      <tr>
        <td></td>
        <td></td>
        <td></td>
        <td></td>
        <td></td>
        <td></td>
        <td></td>
        <td></td>
        <td></td>
      </tr>
      <tr>
        <td></td>
        <td></td>
        <td></td>
        <td></td>
        <td></td>
        <td></td>
        <td></td>
        <td></td>
        <td></td>
      </tr>
      <tr>
        <td></td>
        <td></td>
        <td></td>
        <td></td>
        <td></td>
        <td></td>
        <td></td>
        <td></td>
        <td></td>
      </tr>
      </tbody>
    </table>
  </div>
  <!-- 胰岛素 -->
  <div class="insulin">
    <div class="drugTitle">
      胰岛素:
    </div>
    <form action="" class="drugBtn">
      <input type="button" value="新增">
    </form>
    <table id="insulinTable">
      <thead>
      <tr>
        <th>药物种类</th>
        <th>使用频率</th>
        <th>使用剂量</th>
        <th>操作</th>
      </tr>
      </thead>
      <tbody>
      <tr>
        <td></td>
        <td></td>
        <td></td>
        <td></td>
      </tr>
      <tr>
        <td></td>
        <td></td>
        <td></td>
        <td></td>
      </tr>
      <tr>
        <td></td>
        <td></td>
        <td></td>
        <td></td>
      </tr>
      <tr>
        <td></td>
        <td></td>
        <td></td>
        <td></td>
      </tr>
      <tr>
        <td></td>
        <td></td>
        <td></td>
        <td></td>
      </tr>
      </tbody>
    </table>
  </div>
  <!-- 低血糖反应 -->
  <div class="LowBloodSugar">
    <div class="LowBloodTitle">
      低血糖反应:
    </div>
    <div class="LowBloodDetail drop-down">
      <div class="LowSugar">
        <label>低血糖反应:</label>
        <div class="select">
          <div class="base" id="BloodSugar" data-value="2"></div>
          <span></span>
          <ul class="test">
            <li data-option-value="1">偶尔</li>
            <li data-option-value="2">有时</li>
          </ul>
        </div>
      </div>
    </div>
  </div>
  <!-- 此次随访分类 -->
  <div class="visitSort">
    <div class="visitSortTitle">
      此次随访分类:
    </div>
    <div class="visitSortDetail drop-down">
      <div class="SortDetail">
        <label>此次随访分类:</label>
        <div class="select">
          <div class="base" id="Sort" data-value="2"></div>
          <span></span>
          <ul class="test">
            <li data-option-value="1">控制良好</li>
            <li data-option-value="2">控制不好</li>
          </ul>
        </div>
      </div>
    </div>
  </div>
  <!-- 治疗建议 -->
  <div class="suggestion">
    <div class="suggestTitle">
      治疗建议:
    </div>
    <div class="TreatmentSuggest">
      <label>治疗建议:</label>
      <input type="text" class="treatment">
    </div>
  </div>
  <!-- 转诊 -->
  <div class="referral">
    <div class="referralTitle">
      转诊:
    </div>
    <div class="referralDetail">
      <span class="title">转诊:</span>
      <form action="" class="referralForm">
        <input type="radio" name ="referral" id="referralNo">
        <label for="referralNo">无</label>
        <input type="radio" name ="referral" id="referralHave">
        <label for="referralHave">有</label>
      </form>
      <form action="" class="referralText">
        <label>原因:</label>
        <input type="text">
        <label>机构及科室:</label>
        <input type="text">
      </form>
    </div>
  </div>
  <!-- 转诊回访 -->
  <div class="returnVisit">
    <div class="returnVisitTitle">
      转诊回访:
    </div>
    <div class="returnVisitDetail">
      <div class="date"></div>
      <div class="form-group">
        <label>日期:</label>
        <div id="DateTime" class="input-group date form_date col-md-5" style="width: 146px"  data-date-format="yyyy-mm-dd">
          <input class="form-control" size="12" type="text" value="2015-07-24" readonly style="text-indent:0">
                  	<span class="input-group-addon">
                  		<span class="glyphicon glyphicon-calendar aria-hidden="true""></span>
          </span>
        </div>
      </div>
      <div class="diseaseCheckbox">
        <div class="organTitle">
          <p>靶器官损害:</p>
          <p>合并症:</p>
        </div>
        <div class="organ1">
          <input type="checkbox">
          <label>足病</label>
          <input type="checkbox">
          <label>性病</label>
          <input type="checkbox">
          <label>性病</label>
          <input type="checkbox">
          <label>眼部疾病</label>
          <input type="checkbox">
          <label>神经病变</label>
          <input type="checkbox">
          <label>肝脏异常</label>

        </div>
        <div class="organ2">
          <input type="checkbox">
          <label>足病</label>
          <input type="checkbox">
          <label>性病</label>
          <input type="checkbox">
          <label>性病</label>
          <input type="checkbox">
          <label>眼部疾病</label>
          <input type="checkbox">
          <label>神经病变</label>
          <input type="checkbox">
          <label>肝脏异常</label>
        </div>
        <div class="organ3">
          <input type="checkbox">
          <label>足病</label>
          <input type="checkbox">
          <label>性病</label>
          <input type="checkbox">
          <label>性病</label>
          <input type="checkbox">
          <label>眼部疾病</label>
          <input type="checkbox">
          <label>神经病变</label>
          <input type="checkbox">
          <label>肝脏异常</label>
        </div>
        <div class="organ4">
          <input type="checkbox">
          <label>足病</label>
          <input type="checkbox">
          <label>性病</label>
          <input type="checkbox">
          <label>性病</label>
          <input type="checkbox">
          <label>眼部疾病</label>
          <input type="checkbox">
          <label>神经病变</label>
          <input type="checkbox">
          <label>肝脏异常</label>
        </div>
        <div class="organ5">
          <input type="checkbox">
          <label>足病</label>
          <input type="checkbox">
          <label>性病</label>
          <input type="checkbox">
          <label>性病</label>
          <input type="checkbox">
          <label>眼部疾病</label>
          <input type="checkbox">
          <label>神经病变</label>
          <input type="checkbox">
          <label>肝脏异常</label>
        </div>
        <div class="organ6">
          <input type="checkbox">
          <label>足病</label>
          <input type="checkbox">
          <label>性病</label>
          <input type="checkbox">
          <label>性病</label>
          <input type="checkbox">
          <label>眼部疾病</label>
          <input type="checkbox">
          <label>神经病变</label>
          <input type="checkbox">
          <label>肝脏异常</label>
        </div>
      </div>
      <div class="OtherIllnesses">
        <label>其他疾病:</label>
        <input type="text">
      </div>
      <div class="last">
        <div class="form-group">
          <label>下次随访日期:</label>
          <div id="NextDate" class="input-group date form_date" style="width: 120px"  data-date-format="yyyy-mm-dd">
            <input class="form-control" size="12" type="text" value="2015-07-24" readonly style="text-indent:0">
	                  	<span class="input-group-addon">
	                  		<span class="glyphicon glyphicon-calendar aria-hidden='true'"></span>
            </span>
          </div>
        </div>
        <div class="doctorName">
          <label>随访医生签名:</label>
          <input type="text">
        </div>
      </div>
    </div>
  </div>
</div>
</body>
</html>
